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1959-2011

1959-2011. From small beginnings to a world renowned facility. Mission: “Wholehearted commitment, with God's love and compassion to women with childbirth injuries. . A long and faithful service that started with Midwifery training.

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1959-2011

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  1. 1959-2011 From small beginnings to a world renowned facility. Mission: “Wholehearted commitment, with God's love and compassion to women with childbirth injuries.

  2. A long and faithful service that started with Midwifery training. Midwives trained in the early years but then the project stopped due to lack of Government resources. Mission: “Wholehearted commitment, with God's love and compassion to women with childbirth injuries.

  3. Our main initiatives • Expanded Fistula care • Holistic care- towards reintegration. • Midwifery education and deployment • Emergency Obstetric Care at health centre level. • World Bank improved access project. Hamlin Midwives

  4. Main Site plus 5 locations in Ethiopia. 5 rural Fistula centres • Expansion now complete. • Target capacity increase from 1400 cases/year to more than 4000. • Currently treating about 2800.

  5. Regional Facility- Mekele. Outreach activities appropriate to the demographic and challenges of the region Mission: “Wholehearted commitment, with God's love and compassion to women with childbirth injuries.

  6. Desta Mender Accommodation for up to 100 women, providing training in: Managing their own health, livelihood training and income generation skills- gaining confidence. 12-18 month course tailored to the needs of each woman. Mission: “Wholehearted commitment, with God's love and compassion to women with childbirth injuries.

  7. Desta Mender Dairy Barn where women are producing milk, butter and cheese for sale. Chickens house for Egg production

  8. Committed to the Mission Mission: “Wholehearted commitment, with God's love and compassion to women with childbirth injuries.

  9. Committed to the Mission Mission: “Wholehearted commitment, with God's love and compassion to women with childbirth injuries.

  10. Independent living- Small enterprise Mission: “Wholehearted commitment, with God's love and compassion to women with childbirth injuries.

  11. Facts from Australia: • · Population just over 20 mill people. • · 15% live in rural areas. Good infrastructure. • · 1300 Ob/GynDoctors, 41,000 midwives • · Maternal Mortality rate 8.4/100,000 (2005) Facts from Ethiopia: • · Population of 80mill people • · 85% live in rural areas, poor roads and infrastructure. • . 93% home deliveries no skilled attendant. • · Approx. 130 Ob/GynDoctors, Less than 2000 Midwives, • · Maternal Mortality over 673/100,000 (2007)

  12. Health Care- Ethiopia. • Ethiopia has a total health work workforce of only 55,373 -which translates to 0.7 health workers per 1,000 population • WHO recommended 2.3 health workers per 1,000 population required to attain adequate coverage of essential health interventions (World Health Report, WHO, 2006). • Health worker density ranges from 0.24 per 1,000 population in rural areas to 2.7 per 1,000 population in urban areas. • This poses a serious challenge to the delivery of essential health care services in the country, especially in rural areas where the majority (83.9%) of the country’s population live and work. Mission: “Wholehearted commitment, with God's love and compassion to women with childbirth injuries.

  13. The greatest deficit in health sector workforce density is for physicians, with only one doctor serving 36,158 people • Among physicians, the shortage is most critical for surgeons and obstetricians and gynecologists, with ratios of 1:1.6 million and 1:1.8 million, respectively. • The ratio for midwives is 1: 57,350. • This strikingly low physician-to-population ratio in Ethiopia is a result of a high annual attrition rate of medical doctors, fast population growth and lack of capacity to train doctors fast enough. Federal Ministry of Health’s (FMoH) Health Indicators Survey, 2008 Mission: “Wholehearted commitment, with God's love and compassion to women with childbirth injuries.

  14. Midwifery official opening 2009With Dr Tedros Adahanom Mission: “Wholehearted commitment, with God's love and compassion to women with childbirth injuries.

  15. The Hamlin College of MidwivesVision: A Midwife for every woman “Dedicated with Gods compassion, to train, equip, deploy and support highly skilled, trustworthy and accountable midwives who are willing to serve women and their families in rural Ethiopia”

  16. Questions we asked... • Who would we select • Where will they work • What language do they need to speak? • How will we support them? • Back up ? • How will they continue to develop their knowledge and skills? • Career opportunities for these midwives in the future? • Physical environment. • Knowledge, skills and experience to cope with the demand in a resource poor area ? • What health services /facilities exist?

  17. Midwifery intervention plan • Co-operation with the regional health authorities in selection of location for Midwives. • Promote midwifery to graduating high school girls (Science) in that location. • Select applicants from that region, train them in our college. Return to work in their language/culture area. • Midwives working in and paid by Govt. Health facility, but with support from our regional midwifery supervisor. • We plan to deploy midwives to 25 location in Ethiopia. 5 in each region where we have a Fistula facility. Mission: “Wholehearted commitment, with God's love and compassion to women with childbirth injuries.

  18. Educating midwives ; focus areas: Midwifery from the start, first week, first semester, first year International Competencies; comprehensive and also contextualized Dedicated to developing clinical experience and skills Well experienced MIDWIFE Tutors and Clinical preceptors Improved Assessment 60% pass mark-theory, pass/fail for skills

  19. Focus on Problem solving skills – Enquiry based learning Equipment - available to practice skills…. Multiple re-testing possible, until Competency is reached. Recruit – interested rural women Build confidence! -- win trust.

  20. Deployment model • Deployed in pairs to Government health centre. • Supervising midwife visiting 5 days a month • Connected to referral point for CEmOC by our ambulance- no point putting a midwife where she cannot bring a positive outcome for the woman. • Each health centre connected to 5 health posts- our midwife a link to the community. • Aim to win the confidence of the women in the community- quality, caring service- good outcomes • Developing Midwives as leaders in training for the future Mission: “Wholehearted commitment, with God's love and compassion to women with childbirth injuries.

  21. Improving equipment/supplies/water and power

  22. Emergency access: Provision of an ambulance dedicated to Obstetric emergencies In collaboration , improving roads and building bridges

  23. Retention Points- Rural Midwives • Selected from and returned to home rural areas (culture and language group). • Deployed in pairs • Supply reasonable accommodation. • Supervisor assigned to each location- 5 clinics • Emergency referral Ambulance • Support for equipment and supplies, solution for water and power. • Career path and in service training • Long term service incentives. Mission: “Wholehearted commitment, with God's love and compassion to women with childbirth injuries.

  24. Retention focus areas Peer support Supportive supervision • Supplement Essential drug supply

  25. Midwifery outcomes • Increased from 3 deliveries per months for each site, to over 10, best location averaged 16 births, but growing. • 522 deliveries managed safely, no deaths. • Target for coming period > 25/ month/ location • Significant increases achieved in Ante natal and post natal care take up. • Increase from 5 sites to 11 from Nov2011. Mission: “Wholehearted commitment, with God's love and compassion to women with childbirth injuries.

  26. Engage with the community

  27. Our normal Fistula outreach program: • Short visit to municipality- 7 days • Training for: health workers, HEW, TBA’s, Community and religious leaders, Women’s associations, youth. • Training in: Causes of Fistula, how to avoid it, treatment for as well as identification and pre-treatment. • Cost: Mostly payment for people to attend workshops- approx $3500 in total. • Outcome: 8-12 patients located + awareness Mission: “Wholehearted commitment, with God's love and compassion to women with childbirth injuries.

  28. Fistula Intervention:Focused community action: • USAid funded/ Intrahealth- 3 municipalities- population of each +150,000 (+ 450,000 pop. in total). • Intra-health employed a Fistula focal person and built a waiting house for collection and pre- treatment of patients. • Working with community volunteers- regular meetings and follow up- over 1000 agents. • Over a period of 2 ½ years 811 patients screened 614 sent for treatment from these three areas. • Cost Estimate/ year- $125,000- one location for community interactions (not treatment). Mission: “Wholehearted commitment, with God's love and compassion to women with childbirth injuries.

  29. Phases of intervention Phase 1: Awareness raising in the community about causes of Fistula/ treatment and need for an attended delivery. Phase 2: Locating Fistula patients, pre treatment and sending for treatment/ re-integration. Phase 3: Patient numbers decreasing, time between injury and treatment short/ evaluate location for improved services. Phase 4: Implement prevention plan- either midwifery with referral plan or CEmOC. Once in place Fistula can be eradicated in this location. Mission: “Wholehearted commitment, with God's love and compassion to women with childbirth injuries.

  30. Emergency Obstetric Care- Dangla C-section operations available Working with other agencies we have equipped a rural health center with everything necessary to offer emergency care to women in labout, including c-section operations. In the first 10 months over 84 C-sections performed and the number of overall deliveries at the location trebled. Mission: “Wholehearted commitment, with God's love and compassion to women with childbirth injuries.

  31. Maternal Health plan. Referral point for CEmOC Roadway linking HC to referral Midwife + referral OR- CEmOc Communities, some too far to travel to the health facility and then to a referral point Health Centre Maternal Waiting home. Mission: “Wholehearted commitment, with God's love and compassion to women with childbirth injuries.

  32. World Bank project • Overview- 4 locations in two regions • Improving access to health centre services • Evaluating physical barriers to access. • Determining community concerns and obstacles • Making a plan to open access. • Intervention plan and costs • $500,000 not nearly enough for tracks, small bridges & minor roads and improved transport from rural locations to health centres • 75% of men knew that attended deliver best, but only 4% of women have an attended delivery- no trust in service. Mission: “Wholehearted commitment, with God's love and compassion to women with childbirth injuries.

  33. Some statistics • Cost to operate on one patient- Approx. $450 (But many patients require pre-treatment or post operative care that can be much more expensive). • Overall we are now treating almost 3000 patients/year. • Our work covers: Treatment, other medical care, post operative incontinence management, Physiotherapy, Stoma therapy and counseling, psychosocial counseling, research, prevention, rural patient location, education for health workers and of course Midwifery training. • Overall organization Budget approx. : $4 million • Over 550 staff in 8 organizational units- Main hospital, 5 regional Fistula centers, Desta Mender, Midwifery college. • Midwife sponsorship, $4000 Au/yr (4 year course). • Rural Midwifery clinics- opened in Sept.2010- we plan to have a total of 25 by the end of 2014.- Cost- $28,000/yr for each clinic- serving a rural population of 150,000 - 200,000 people. Mission: “Wholehearted commitment, with God's love and compassion to women with childbirth injuries.

  34. Addis Ababa Fistula Hospital, Ethiopia. Mission: “Wholehearted commitment, with God's love and compassion to women with childbirth injuries.

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